Transatlantic research to improve heart disease treatment

Doing world-leading research means broadening your horizons. For Dr Marc Dweck, a year in New York helped him develop advanced ways to spot and treat heart problems, as he tells Sarah Brealey.

What do you do if you want to work with top experts in your field? If you’re a BHF-funded researcher, you might cross the Atlantic to meet them. That’s what Dr Marc Dweck, Senior Lecturer and Consultant Cardiologist at the University of Edinburgh and Edinburgh Heart Centre, did. As part of his BHF-funded Clinical Research Fellowship, he spent a year in New York, working with world-leading experts in scanning the heart and the arteries.

“I wanted to work with Dr Valentin Fuster, based at Mount Sinai Hospital in New York,” says Dr Dweck. “He is one of the top cardiologists in the world and I wanted to see how he runs his clinical and research teams. I was working under Dr Zahi Fayad, Director of the Translational and Molecular Imaging Institute at Mount Sinai. He is an inspirational and charismatic guy who has pioneered the latest cutting-edge imaging techniques to look at heart disease.”

I wanted to work with Dr Valentin Fuster, based at Mount Sinai Hospital in New York

It often meant meetings at 5am or late at night, but Dr Dweck says it was worth it. “Those guys are really busy, effective people, and I had to get up early in the morning to try to meet them,” he says. “They have a fantastic work ethic and I was grateful to spend some time with them.”

As well as learning from the best people, he had a chance to use the best equipment. “I was using a state-of-the-art scanner,” he says. “The idea was that I would go out there to learn how to use the scanner, and then bring that knowledge back. We now have one installed in Edinburgh and I’ve started to use it here, based on my learnings from New York. There is a whole programme of research into heart disease that is using this new machine.”

Using scanners for detailed study

The multi-million-pound scanner – one of the most complex machines of its kind – is a PET-MRI scanner. This stands for positron emission tomography (PET) combined with magnetic resonance imaging (MRI). PET means that scientists can look at processes inside the human body, at a molecular level, while MRI can show fine detail in body tissues.

In his work in New York, Dr Dweck was studying the heart muscles, trying to use scans to see disease-causing processes within the molecules inside our cells – processes far too small to see with the human eye.

The scanner will allow researchers to see what effects the drugs have on the valve

This could help diagnose rare types of heart failure, including cardiac amyloidosis, which can be fatal without treatment. “These are quite rare conditions that are difficult to diagnose, and need a number of different tests to diagnose them,” explains Dr Dweck. “PET-MRI seems to give you all the information that you need in a single test.”

The expertise he has gained in PET is now being used in a BHF-funded trial at the University of Edinburgh. The trial will test the effects of two drugs on aortic stenosis – the most common type of heart valve disease, in which the aortic valve in your heart becomes stiff and narrow, so the heart struggles to pump blood. The only cure is surgery to replace the valve. The scanner will allow researchers to see what effects the drugs have on the valve.

Another focus of Dr Dweck’s research is the fatty plaques that build up in arteries, especially as we get older. If one of these ruptures, it can cause a heart attack or stroke. Dr Dweck has spent years working on ways to spot plaques likely to rupture, so we can identify and treat high-risk patients. This has been done with a combination of PET and CT (another type of scan), but during his stay in New York, Dr Dweck and colleagues established that PET-MRI is another way to do this. He also studied plaques in the neck arteries, to try to predict risk of stroke. Since returning to Edinburgh last year, he’s been working on another trial to improve the prediction of heart attacks, by scanning plaques in the arteries.

Dr Dweck with his wife Caroline

Family life in New York

It wasn’t just Dr Dweck’s knowledge that expanded overseas, his family grew too. “Louis, now 16 months, was born in New York,” he says. “So we experienced the American healthcare system as a patient too. It nearly meant we couldn’t go, because we couldn’t get conventional health insurance for Caroline while she was pregnant. Luckily Mount Sinai stepped in to offer me an official position so that the health insurance came with it.”

Understandably, Dr Dweck’s wife Caroline, a GP, was initially sceptical about relocating the family to New York while pregnant. However, they soon discovered many benefits. They were able to stay in a tiny but perfectly located hospital-owned flat on Madison Avenue, next to Central Park, and Tom and Eva, then five and three, thrived in school and nursery.

The connections I built will continue and develop over the next 10 to 15 years

“Hardly anyone in New York is from New York, so you quickly feel part of the city,” says Dr Dweck. “Central Park is a brilliant place for the kids and my wife really loved all the museums and art galleries. We all had an amazing time in the end, the energy of New York is really infectious.”

Dr Dweck’s whole research career has been funded by the BHF, and it was BHF support that enabled him to go to New York. “As part of the intermediate fellowship you are encouraged to go away for a year,” he says. “You have to think about where will add value to you and be helpful to your career.”

Although his time in New York is over, the experience will benefit his work for years to come. “There is only so much you can do in a year in terms of research, but the connections I built will continue and develop over the next 10 to 15 years,” he says. “That is really valuable.”

Heart health in Harlem

During Dr Dweck’s year in New York, he worked on a project to reduce local residents’ risk of heart disease, while gathering information for research.

As part of an American Heart Association-funded study, he and colleagues visited schools in the Bronx and Harlem. They gave advice to schoolchildren and their families about healthy eating and exercise, to reduce their risk of heart disease. This is part of a global programme trying to improve health attitudes and behaviours within families.

“We took our ultrasound scanner and were scanning plaques in the neck of the children’s parents,” says Dr Dweck. “Often we were able to identify the early stages of disease, which can lead to stroke. If you can show someone plaques inside their own body, that is quite a strong incentive to have a more healthy lifestyle.”

The study brought extra benefits for some of the New Yorkers involved. “In some people we found quite advanced disease,” says Dr Dweck. “They were then referred for follow-up, and received medication and other treatment as a result.”

Lifestyle messages haven’t been lost on Dr Dweck himself, who has a family history of heart disease.

“The Dwecks all seem to have heart attacks at an early age, often in their 30s and 40s,” he says. “I am 37 at the moment, so I am thinking I had better watch what I am doing.

“The job does make you realise the importance of lifestyle, like eating healthily, exercising and not smoking, to reduce your risk of heart attacks. I spend a lot of time telling my patients to do these things, so I have to do them as well.”

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